This role will manage relationships with strategic high volume ancillary providers within the UPMC Health Plan service area. Provide assistance and support to other assigned ancillary providers and its staff enabling them to resolve daily operational issues, as necessary. Evaluate the effectiveness of ancillary providers and operational processes and assist the practice in developing action plans and identifying resources to impact change. Recruit and contract to ancillary providers and lead a team of professionals, who will be instrumental in improvement of patient outcomes, member satisfaction and cost control. Work with a broad spectrum of UPMC Health Plan personnel, network providers, and external resources to complete all tasks related to network management projects, goals and objectives.

Responsibilities:• Assist Manager in coordination of staff development and training. Mentor by accompanying Network Managers to appointments when needed. • Assist in development of networks, by market segment to increase UPMC Health Plan ancillary network adequacy. Create and lead team to impact change.• Distribute provider reports, lead development and implementation of action plans. • Identify, document and distribute best practice information.• Manage relationships with key high volume accounts within the UPMC Health Plan ancillary network. • Manage special projects assigned by manager and department director.• Meet deadlines and turnaround times set by manager and department director (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).• Meet with targeted ancillary practices to assess practice patterns and make recommendations to improve provider performance. • Monitor large claims and operational issues to ensure successful resolution.• Provide information on plan resources to assist. • Track and document success and report results to practice and to management.

Qualifications

B.A. degree in business, health care, finance, or related field or 5 years of experience in managed care/physician office setting required.

Excellent verbal and written communication skills, analytical and organizational skills are required.

Extensive problem solving experience is required. Presentation experience and experience working with physicians.

Goal-oriented and have experience with development and implementation of action plans. Leadership skills are desired.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

This role will manage relationships with strategic high volume ancillary providers within the UPMC Health Plan service area. Provide assistance and support to other assigned ancillary providers and its staff enabling them to resolve daily operational issues, as necessary. Evaluate the effectiveness of ancillary providers and operational processes and assist the practice in developing action plans and identifying resources to impact change. Recruit and contract to ancillary providers and lead a team of professionals, who will be instrumental in improvement of patient outcomes, member satisfaction and cost control. Work with a broad spectrum of UPMC Health Plan personnel, network providers, and external resources to complete all tasks related to network management projects, goals and objectives.

Responsibilities:• Assist Manager in coordination of staff development and training. Mentor by accompanying Network Managers to appointments when needed. • Assist in development of networks, by market segment to increase UPMC Health Plan ancillary network adequacy. Create and lead team to impact change.• Distribute provider reports, lead development and implementation of action plans. • Identify, document and distribute best practice information.• Manage relationships with key high volume accounts within the UPMC Health Plan ancillary network. • Manage special projects assigned by manager and department director.• Meet deadlines and turnaround times set by manager and department director (these deadlines and turnaround times will, at times, require the employee to work until the project is completed, meaning extended daily work hours, extended work weeks, or both).• Meet with targeted ancillary practices to assess practice patterns and make recommendations to improve provider performance. • Monitor large claims and operational issues to ensure successful resolution.• Provide information on plan resources to assist. • Track and document success and report results to practice and to management.

Qualifications

B.A. degree in business, health care, finance, or related field or 5 years of experience in managed care/physician office setting required.

Excellent verbal and written communication skills, analytical and organizational skills are required.

Extensive problem solving experience is required. Presentation experience and experience working with physicians.

Goal-oriented and have experience with development and implementation of action plans. Leadership skills are desired.

UPMC VALUES

At UPMC, our shared goal is to create a cohesive, positive, experience for our employees, patients, health plan members, and community. If you too are driven by these values, you may be a great fit at UPMC!

UPMC provides a total rewards package that can help you achieve the goals you have for your career and your personal life. Whether you want to learn a new skill through a training course, reach personal health and wellness targets, become more involved in your community, or follow a career path that provides you with the right experience to be successful, UPMC can help you get to where you want to be.

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